Getting to Know You: An Individual Difference Approach Beginning with Sensory Assessment

1. Getting to Know You: An Individual Difference Approach Beginning with Sensory Assessment Ontario Ministry of Children and Youth Services Tanni L. Anthony Kevin Stewart July 4th, 2007

2. Today’s Learning Objectives • To understand the individual differences approach. • To understand sensory development. • To be able to implement basic tools of functional sensory assessment. • To identify and be able to implement strategies to support functional sensory development.

3. T. Berry Brazelton, 1993 It is in the first weeks and months of life that children first try to understand and master their environment; and find their efforts encouraged – or not; First attempt to concentrate and find it possible – or not.

4. First conclude the world is orderly and predictable – or not. First learn that others are basically caring –or not; It is in these years that the foundations for later learning are laid down – or not

5. Common Language • Visual Impairment(umbrella term) • Legally Blind(20/200 or 6/30, 2o°, medical / eligibility determination) • Blind(without any sight) • Functionally Blind(vision as a secondary channel) • Low Vision(vision is primary modality, but affected) • Visual Problem(potentially treatable vision concern, but that will require medical referral and perhaps some educational support)

6. Developmental Difference / Adaptive Task Approach Questions to Ponder • How does the child, given his/her capabilities, engage the environment? • How does the environment afford meaningful and purposeful interactions? • What, given these features, is the resulting learning behaviours observed?

7. Setting the Stage “To observe, infer or interpret the behaviours of a sightless person demands not an understanding derived from sighted experiences, but a radically different conceptual framework.” “To proceed with a child who is blind in the same manner as a child who is sighted is both unjust and unfair.” (Nesker Simmons & Davidson, 1991)

8. “The opportunity to be equal, • and the right to be different.” • (Hatlen)

9. Understanding the Child: Personal Variables • Family Constellation / Birth Order • Family Support Systems • Temperament • Age of Onset and Severity of VI • Presence of Other Conditions / Disabilities • Unique Developmental Path

10. Understanding the Child: Environmental Variables • Opportunities to experience daily events to access the: - physical world - social/emotional world - learning setting

11. Temperament is Part of the Equation Temperament refers to the infant’s behavioral style or disposition (Thomas and Chess, 1977) “Goodness of fit” is key to the caregiver infant relationship. Temperament and caregiver responsiveness contribute to the mental / emotional development of infants

12. Dimensions of Temperament • Activity Level: inactive versus active motor behavior. • Rhythmicity: regularity of schedule, predictability versus unpredictability of behavior. • Approach or Withdrawal: typical initial response to new stimulus

13. Dimensions of Temperament • Adaptability: response to change in routine. • Sensory Threshold: level of stimulation needed to evoke a response. • Intensity of Response: energy level of response.

14. Dimensions of Temperament • Quality of Mood: degree of pleasant, happy, and friendly behavior versus unpleasant, unhappy, and unfriendly • Distractibility: the extent to which extraneous stimuli interfere with or change ongoing behavior. • Persistence and Attention Span: length of time an activity is pursued and the continuation of an activity in the face of interruptions or obstacles.

15. Flexible, Fearful, or Feisty The Different Temperaments of Infants and Toddlers CA Dept. of Education P. O. Box 944272 Sacramento, CA 04244

16. Flexible – about 40% of children • Regular Rhythms • Positive Mood • Quick to Adapts • Low Intensity • Low Sensitivity Need special attention so they do not get lost in the group. May not be as obvious with needs. Want to “check in” with this child, as he or she may not be overly overt with needs.

17. Feisty or Fussing – 10% of children • Active • Intense • Distractible • Sensitive • Irregular • Moody Children are intense – fun and frustrating. Can use redirection of attention. Helpful to be flexible and adapt to the child who defies a schedule. Be sensitive to child’s response to sensory information (touch, light, noise). Peaceful settings and preparation with transitions are important.

18. Fearful – roughly 15% of children • Slow to adapt. • Withdraws May be called shy. If pushed to join in, may cause withdrawal. Helpful to provide preparation for new activities. Watch for emotion to shift from caution to enjoyment before stepping back. Provide a space of the child’s own.

19. Brain Development in Infancy • A “hot topic” around the world. • We now realize “wiring opportunities.” • This information readily applies to children who have sensory disabilities.

20. Importance of Brain Development • The environment affects not only the # of brain cells and the # of connections made, but also the way the connections are “wired.” • There is evidence of the negative impact of early stress upon brain function.

21. Sensory Development • Our senses are our external avenues of learning. - senses (input in) - motor (input out) • Sensory-based learning begins in utero and continues through the rest of our lives.

22. Practices of Yesteryear … • Sensory bombardment in the intensive care unit in the 1964 - 1970s. • Sensory stimulation kits & black and white commercial materials in classrooms.

23. Now our job is to . . Analyze and build an environment that is supportive of sensory learning.

24. “Perceptual information obtained through the senses and the processing of this information facilitates the child’s understanding of his physical and social environment.” (Stewart & Cornell, 2004, p. 87)

25. Sequence of Sensory Development • Touch • Vestibular / Proprioception • Taste • Smell • Auditory • Vision

26. Touch • Received from the skin. Fingertips have highest tactile sensitivity / discrimination sensors. • Provides information about temperature, touch, pressure, and pain. • How we are touched makes a difference -whether we are threatened or comforted. As such, touch is linked closely with one’s emotions. • Develops head to toe. At birth – focus is on protective touch. With time – discriminative touch.

27. Touch • The temperature regulation boundaries of the womb begin the process. • There are 2 systems: discrimination (child touches something or feels being touched) and protection (touch is registered as dangerous or uncomfortable)

28. Touch in Utero No light touch in the womb, only deep pressure touch. There is continually “resistance feedback.”

29. Role of Touch • Touch is rudimentary to infant/caregiver attachment and for providing the platform of emotional security for future learning behavior. “Tactile sensations are the primary source of comfort and security (Ayres, 1981, p. 62). • Rosen (1977) described touch as an interface between children and their environment, both what touches them and what they touch. She noted six types of sensory information that the sense of touch can detect: deep touch, light touch, vibrations, pain, temperature, and two-point touch (ability to identify how many points of contact an object has with the skin, such as a braille cell with fingers).

30. Four Unique Touch Abilities Touch encompasses four unique sensory abilities, each with their own specific neural pathways. Feeling something with one’s skin and specialized nerve receptors is cutaneous sensation.

31. Four Unique Touch Abilities Pain and temperature sensations are also accomplished through the skin and specialized nerve receptors. The fourth sensory ability is proprioception or the sense of position and movement of one’s body. Proprioception will be addressed in the following section on Vestibular and Proprioception.

32. Touch and the Child Who is Deafblind • With compromised / absent vision and hearing, touch will be a primary modality for many children who are deafblind. • As such, care should be taken to ensure the world is a “safe and predictable” place to reach out, touch, explore, and find.

33. The Power of the Tip of a Finger • 9 feet of blood vessels • 600 pain sensors • 36 heat sensors • 75 pressure sensors • 4 oil glands • 9,000 nerve endings

35. Haptic Perception (Bushnell & Boudreau, 1993) • Birth - cannot tactilely discriminate the characteristics of an object placed in their hands. • 10 weeks of age - begin to distinguish between differently sized and shaped objects held in their hands. • 6 months - can tactilely perceive temperatures, hardness, and textures through touch and handling of objects • 9 months - weight perception is evident • 12 to 15 months - can perceive differences of the spatial arrangement of shapes with similar features

36. Assessment Considerations • How well does the child use his or her hands? • Is the child alert to vibration and touch? • Does the child handle objects with some caution? • Is the child interested in differences of texture and detail? • Does the child explore with curiosity? • Does the child recognize objects through touch?

37. Assessment Considerations • Does the child have a tactile means of identifying people? • Does the child interact with you physically? • Does the child touch you only as an object or as a source of affection, help, and/or enjoyment? • Does the child allow you to guide him or her physically in order to show him/her things? (Remarkable Conversations, 1999)

38. An Important Distinction Tactile Defensiveness • Avoidance of touching (“Lack of integration of the early protective touch (protopathic ) system which results in delays in the development of later, higher level discrimination touch (epicritic) system.” Strickling, 1998, p. 9) • Hypersensitivity • Feels aversive Tactile Selectivity • Resistance to touch • No preparation • Poor information • Dislike texture • Not interested • Unsure of time frame

39. Scenario: Touch and Auditory Cueing • Diaper Changes that were tense for baby • As his mom, approaches Andrew she takes care to softly call out to him. Once she is next to him, she places her hand on his side and waits for his response. Andrew adores his mom and usually wiggles with excitement when she is next to him. As he smiles and goos, she nestles next to him.

40. Scenario: Touch and Auditory Cueing • If his diaper is in need of changing, she pats his side and tells him that she is going to change him. While Andrew is being changed, he can play with the diaper in his hands. • When diapering is finished, she announces “all done!” • As time has passed, his mother has noticed that all she needs to do is announce the diaper change and Andrew knows what will be happening to him. Although he does not always like to stay still during the diaper change, he is no longer visibly upset with the activity

41. Vestibular (subcomponent of touch) • Receptors in inner ears sense changes of one’s position in space (specifically one’s head in space). • Provides information what direction our bodies are moving, how fast we are moving, and if we are speeding up or slowing down. • Affects arousal state and helps organize movement, enhance spatial awareness, and develop muscle tone. Motor development is tied to vestibular system. • Inadequate vestibular input = problems with muscle tone, bilateral integration, and midline orientation (Strickling, 1998)

42. Vestibular

43. Proprioception (Subcomponent of Touch/ Body Position) • Muscles and joints give one a sense of the position of one’s body in space. activated through sensory receptors located in the tendons, muscles, and joints of the body. • Influenced greatly by visual feedback. Sighted children watch their bodies move in space. • Proprioception is process by the CNS together with vestibular and visual information. When there is a vision loss, it is more than a loss of a sensory system – the use of vestibular and proprioceptive input is affected (Strickling, 1998).

44. Taste • Closely linked to smell. Both are functional at 28 weeks gestation. By last trimester, baby can taste the food that the mother eats. • Chemically perceived by receptors on the tongue. Special receptors on different parts of the tongue are sensitive to salty, sour, bitter, and sweet tastes.

45. Smell • Received chemically from receptors in the nose. By last trimester, the baby can smell odors from outside the womb. • Smell sensations go directly into the emotional center of the brain.

46. Olfactory Development

47. Hearing Development • Sound is carried by airways and captured and registered by receptors in the ears.

48. Sequence of Auditory Localization • sounds presented directly at ear level; • sounds presented at ear level and downward; • sounds presented at ear level and upward; • sounds presented directly upward, and • sounds presented in front of child’s body and at almost any other angle

49. Hearing and the Child Who is Deafblind • There may be no difference in sounds in the background and sound in the foreground – increased challenge for the child to sort out auditory information.

50. Assessment Considerations • Cause / prognosis / treatment / implications. • Loudness needed to hear a sound. • What sounds can the child hear and not hear? • Can the child hear speech at normal levels? • Is there a history of ear infections?